Health Forms

Listed below are various Health & Counseling forms available for download; except where indicated, all forms are in PDF format. If you have any questions about any of these forms, please call Health Services at 585-245-5736 or Counseling Services at 585-245-5716.

Verification of Student AbsenceHealth Services will provide documentation of visits of the student to professors, employers, or others provided that the student signs an Authorization to Release Information. Professors and other campus personnel requesting this information must ALSO submit the online form below.Verification of Student Absence(online form)

Incoming Student Forms

Incoming Student ChecklistIf you are an incoming student, please download this form to ensure that you have submitted all of the required information.Incoming Student Checklist (PDF)

Physical ExamIf you are an incoming student, please download this form for your doctor's office to fill out.Physical Exam(PDF)

Minor Student Forms

Consent for Medical Treatment of MinorsIf you are under the age of 18 you will need to provide parental consent for medical treatment.Consent for Treatment of a Minor(PDF)

Minor Students Seeking CounselingIf you are under the age of 18 and seeking counseling services, you will need either provide parental consent OR document that your parents have refused/are unable to provide parental consent. The first form below is the Parental Consent Form; the second is the Minors' Consent Form.

Religious ExemptionIf you hold a deep religious conviction that prohibits you from participating in the routine vaccination program, you need to fill out the form and submit it as a waiver for the New York State required immunizations.Religious Exemption(PDF)

Counselor Change RequestIf you have been seeing a therapist in Counseling Services and would like to work with someone new (same academic year), print the form below, complete the requested information, and drop it off at Counseling Services, Lauderdate 205.Counselor Change Request (PDF)